Third in the series. This one covers our future nurse shortage, too.
More than a year and a half after Texas implemented its six-week abortion ban, and months after Dobbs, medical providers say they are facing impossible situations that pit their ethical obligation to patients who are dealing with traumatic and dangerous pregnancy complications against the fear of lawsuits, loss of their medical licenses, and incarceration. The problem is encapsulated by a lawsuit filed this month in Texas, in which five women and two OB-GYNs sued the state over the abortion bans that they say have created so much confusion and fear among providers that it has affected women’s health and even threatened their lives. Unsure of how to comply with the new rules, hospitals have interpreted them differently, with some requiring approval from attorneys or ethics boards for physicians to provide abortion care in medical emergencies, and others leaving it up to individual doctors, with little guidance or support. This has meant that some physicians wait until patients are near death to intervene in medical emergencies, according to recent research, court filings, news reports, and interviews. “I’ll get consults from another doctor asking me what to do in a particular case—a mother bleeding, or a pregnancy where there’s an infection in the womb before the baby can survive outside the womb. I have doctors calling me, hesitating, not quite knowing what to do because the baby has a heartbeat, when clearly the mother’s life is at risk,” John Visintine, a maternal fetal medicine specialist in McAllen, Texas, told me. “These are things that I haven’t seen in, you know, 20 years of practicing OB, 14 years of practicing high-risk OB—I’ve never run into these situations where people are wondering what to do.”
The inability to provide what they say is the standard of care to pregnant patients is taking a toll, personally and professionally, according to interviews with more than a dozen doctors and nurses across Texas. And it’s causing many, like Wilson, to reconsider the future of their career in the state. Almost every provider I spoke with for this story has thought about leaving their practice or leaving Texas in the wake of S.B. 8 and Dobbs. Several have already moved or stopped seeing patients here, at least in large part because of the abortion bans. “If I was ever touch a patient again, it won’t be in the state of Texas,” said Charles Brown, chair of the Texas district of the American College of Obstetricians and Gynecologists (ACOG), who stopped seeing patients last year after decades working as a maternal fetal medicine specialist. Many asked that their hospital affiliation not be included in this story, in some cases because they feared consequences from their employer or the public for speaking out about these laws, even though they’re not breaking them. Some worry about what will happen to their own kids if they are targeted. Several cried through the interviews. Many of those I spoke with who haven’t left yet are still thinking about it regularly—people who have family and homes and lives in Texas and would not otherwise have considered moving.
Brown put the stakes bluntly: “Are people quitting? … The answer is yes,” he said. “I hope I’m 100 percent wrong about this, but I think it’s a much bigger trend that’s going to become obvious pretty quickly.”
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This is all happening as Texans can’t afford to lose more access to medical care. In 2022, 15 percent of the state’s 254 counties had no doctor, according to data from the state health department, and about two-thirds had no OB-GYN. Texas has one of the most significant physician shortages in the country, with a shortfall that is expected to increase by more than 50 percent over the next decade, according to the state’s projections. The shortage of registered nurses, around 30,000, is expected to nearly double over the same period. Already, Texans in large swaths of the state must drive hours for medical care, including to give birth. According to recent research from the nonprofit March of Dimes, it is among the worst states for maternity care access, which has decreased in a dozen Texas counties in the past two years, mostly due to a loss of obstetrics providers.
This doesn’t yet take into account the effects of increased criminalization of abortion care, which is further compounded by dramatic pandemic-induced burnout among clinicians. As physicians retire, hospitals are struggling to replace them; as nurses burn out or leave for more lucrative travel nursing roles, their positions are sitting open. There have been a string of policies and factors that have stretched providers in Texas for many years, from having the highest uninsured rate in the country to low Medicaid reimbursement rates to the demonization of science to attacks on transgender health care, and now the abortion bans, according to Tom Banning, the CEO of the Texas Academy of Family Physicians. “The first rule of holes, when you’re trying to get out of the hole, is to stop digging,” he said. “We just continue to dig the hole that we’re in deeper.”
This is an issue for both urban and rural areas, but it’s felt most acutely outside major metros, where one retirement or move can be the difference between having access to medical care near home or having to drive an extra several hours. The state has experienced the most rural hospital closures in the country in recent years. Less than half of rural hospitals nationwide still have labor and delivery services, according to recent research from the Chartis Center for Rural Health; in Texas, that number is just 40 percent. John Henderson, the president and CEO of the Texas Organization of Rural and Community Hospitals, said he gave a presentation this fall for a group of representatives from about 100 rural Texas hospitals where he asked them to raise their hand if they don’t currently have openings for registered nurses. “There were three out of 100 that were fully staffed, and I was actually surprised that there were three,” he said. “It’s crisis-level staffing for the majority of rural Texas hospitals.” Maternity wards have long been the sacrificial lamb for cash-strapped rural hospitals trying to save money and keep their doors open, but more recently, it’s short staffing that has forced closures and cuts to services in Texas and across the country.
See here and here for the previous entries. The problems with rural hospitals and the general unavailability of maternity care are separate but related phenomena. I realize that the plural of “anecdote” isn’t “data”, but there sure are a lot of anecdotes, and some of them do come with data, so.
It is of course possible that none of this gets beyond the anecdote stage. Some of the people quoted in the story admit that it’s tough to leave even as they get pushed past what they thought their point of tolerance was. Maybe the effect will only be truly felt in rural areas where they keep on voting for the Republicans that create and exacerbate these problems for them. Maybe it’s dumb to expect Republicans to feel the consequences for any of their actions, given that they haven’t felt them for the freeze or for the continued epidemic of mass shootings. I don’t know what’s going to happen. But as long as these stories keep getting written, I’ll keep pointing them out.
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